Jennifer Ferreri/Bear, Stearns & Co., Inc.m MIAMIBEACH
City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel during the time
period of the entire decision-making process on such action, decision or recommendation that foreseeably will be heard or reviewed
by the city commission, or a city board or committee. The term specifically includes the principal as well as any employee engaged
in lobbying activities. The term "Lobbyists" has specific exclusions. Please refer to Ordinance 2004-3435.
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NAME OF LOBBYIST: (Last) (First) (M.I)
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BUSINESS NAME AND ADDRESS (Number a d Street) (City) (State) (Zip Code)
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NUMBER:
FAX NUMBER:
EMAIL:
I. LOBBYIST RETAINED BY:
NAME OF PRINCIPAL/CLIENT:
~ I IQad SC~tI ~t lf'e -
BUSINESS NAME AND ADDRESS (Number and
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TELEPHONE NUMBER:
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(City)
t3ury
FAX NUMBER:
(State) (Zp Code)
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EMAIL:
Fill out this section if principal is a Corporation, Partnership or Trust
• NAME OF CHIEF OFFICER, PARTNER, OR BENEFICIARY:
IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST:
-rye, .~-eau- S-I-~ rn s ~ ~ ~n ~ ~~, ~ ~% 5 ticer~c ~ c~r-
II.
Issue
III.
SPECIFIC LOBBY ISSUE:
h~ c.i ~~ l boric( ~1-- ~~(a-~-e~ --~nao~ c1c~ ~ .mot-u~c~ s
in detail):
CITY AGENCIES/INDIVIDUALS TO BE LOBBIED:
A) Full Name of Individual/T"itle B) Any Financial, Familial or Professional Relationship
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IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURLY,
FLAT RATE OR OTHERr ,
A) LOBBYIST DISCLOSURE: (Required)
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION):
The following information must be answered:
1)
2)
v
Pursuant to Miami Beach City Code Section 2-488 Entitled "Prohibited Campaign Contributions By Lobbyists
On Procurement Issues":
Pursuant to Miami Beach City Code 2-490 Entitled "Prohibited Campaign
Estate Development Issues":
Mau?
By Lobbyists On Real
3) Pursuant to Miami Beach City Code 2-484 (h) Any person (except those exempt from the definition of
"lobbyist" as set forth in Section 2-481 above) who only appears as a representative of anot-for-profit
corporation or entity without special compensation or reimbursement for the appearance, whether direct, or
indirect, to express support of or opposition to any item, shall register with the clerk as required by this
section but, shall not be required to pay any registration fees..
~- Yes ~ o• Are you rearesentina snot-for-profit corporation or entity without special compensation
or reimbursement. .
V. SIGNATURE UNDER OATH:
ON OCTOBER 1~ OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPEND~URES OR COMPENSATION DURING THE
REPORTING PERIOD. ,
of
I do solemnly swear that all
familiar with the provisions c
requirements. ,
e ,.
Signature of Lobbyist: ,,
of the foregoing facts are
-~tained in Section 2-482 c
Signature of Principal/Cli~nt~: ~
VI. LOBBYIST IDENTIFICATION:
Produced ID
Form of Identification
`/~rsonally known (Lobbyist)
VII. SIGNATURE AND STAMP OF NOTARY:
co ect nd that I have read or am
mi Be City Code and all reporting
PRINCIPAL IDENTIFICATION:
Produced ID ~~~~~~•t'~ ~
Form of Identification
Personally known (Principal)
State of Florida, County of Miami-Dade State of Florida, County of Miami-Dade
Sworn to a~ subscrib d b fore me Sworn and subscribed hefore me
This ~~ ~h~r 20 v`7 This _ `-_% day of ~~~7_ '>~.-'rte , 211"
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" A`I'F. ®F FLORID/t !'"~ i~/ ~rZ~ ~.~4~
Signature ubli otary - ~e . Floric~Shua ~lIlg Signature of Public Notary -State of Flor
Notarizat" n of byis mission #p$3,78244Notarization of Principal's signature
,(/~ond'edThraAaant~~ ~IL~r9NLY 1 `;j
Annual Registration fee: ll'~' ]Yes [ ] No Amou P ~,~~ y. "MCR V~/ Date Paid
Lobbyist Registration Form received and verified by: !~~
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